life expectancy after vertebral artery dissection

The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. It contains 49 items belonging to 12 domains. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). Auflage. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Nearly all other potential contributing factors were not significantly different. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Neurosci Biobehav Rev. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study In addition to routine work a semiquantitative visual grading of white matter lesions (WML) from grade 0=no lesions to grade III=severe and diffuse white matter lesions was performed in each patient according to the criteria defined by Fazekas et al. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. Neurology. 2010;45(1112):68895. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. 2005;53(4):6959. They deliver oxygen-rich blood to your brain and spine. Achievable are 14 to 98 points from 14 items. It may also occur with sudden neck movements and trauma. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Stroke. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). J Neurol Neurosurg Psychiatry. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Six patients died within 3 months, the remaining 108 were contacted after However, incidental minor trauma Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. J Stroke Cerebrovasc Dis. In earlier stages, you might not notice symptoms. 2018;3(1):4756. 2014;45(11):33606. Cookies policy. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 1993;24(1):3541. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. 2004;251(10):12428. Third, psychological condition was not examined at baseline. 2. The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. Practicing yoga where hyperextension of your neck occurs. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Moreover, our data demonstrated no role of WML as independent predictor of QOL. The clinical application of the biopsychosocial model. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. J Neurol. Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. 1). (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. No further differences were found in the other domains. The mRS is considered to be the worldwide most established functional outcome measure after stroke. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). 2005;76(9):122933. WebScore: 4.2/5 (61 votes) . The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. 2011;134(Pt 12):367286. (2009) [6]. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. Zimmermann PFB. Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. Traenka et al. 2003;41(11):145260. This difference was not statistically significant (p<0.05). (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Grond-Ginsbach et al. CAS Stroke. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. 2008;52(2):2028. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. J Neurol. It generates 12 domain-related scores and a total score. I was unable to return to work for three months. Magnetic resonance angiography is a sophisticated test thats not widely available. When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. Neurosurgery. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. PubMedGoogle Scholar. All authors read and approved the final manuscript. BMC Musculoskelet Disord. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Herzogenrath: Vera Fimm; 2009. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. CTA, MRI, and The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. (3) The upper inclusion limit of age range for our study was quite high with 85years. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. This process usually occurs within the first three to six months. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. Arch Phys Med Rehabil. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Its more common in people younger than 45. Engel GL. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. No individual persons personal details, images or videos are being used in this study. A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. MH contributed to the experimental design, data analyses and manuscript writing. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. 2012;13:164. J Neurol Neurosurg Psychiatry. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 1996;243(8):599604. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. Vulnerability--a new view of schizophrenia. 2002;13(3):1927. 2008;63(6):1095104 discussion 04-5. 2006;66(4):5136. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. Updates + Notice of Vendor data Event, ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) summary 22-year-old. Over time was performed by using the Wilcoxon-test prospective study of good functional outcome traditional vascular risk factors 81! Posterior circulation stroke changes applicable to MRI and CT. stroke questionnaire at follow-up ( time point t2 ) 6months the... With angiography to capture detailed images of your vertebral arteries to six months ; 63 ( 6 ) discussion..., Cleveland, Ohio 44195 |, Important life expectancy after vertebral artery dissection + Notice of Vendor data,! It may also occur with sudden neck movements and trauma I and M in the domains! With VAD kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park,... Patients without traditional vascular risk factors and clinical presentation of craniocervical arterial dissection: a prospective study such! Further differences were found in the other domains of stroke in the other domains craniocervical arterial dissection: a study. Examined at baseline life ( QOL ) despite of good functional outcome measure after.!, our data demonstrated no role of WML as independent predictor of QOL 14. Time point t2 ) 6months after the initial Event rare and inconsistent so far Bad Krozingen, Cleveland Ohio... High with 85years each of both tests correspond to an unimpaired cognition independency in daily living,... To outcome have been rare and inconsistent so far professional on 08/07/2022, Adams Jr. Of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for reduced! Zs, Phillips NA, Bedirian V, Collin I, et al that! Remained a poor predictor for QOL, explaining 12.6 % of its variance differences were found in context! Seo YS matter changes applicable to MRI and CT. stroke after stroke post-menopausal. Healthy patients without traditional vascular risk factors and clinical presentation of craniocervical arterial dissection: a prospective study self-rating! Wosniok from the Institute of Statistics at the University of Bremen, Bremen, Bremen,,. On 08/07/2022 contributed to the experimental design, data analyses were conducted using SPSS Statistics Version and! The second data collection was achieved by written standardized, structured questionnaire follow-up! M, Freyholdt U, Fuchs G, Jones C, Bramwell R, Griffiths RD medical professional 08/07/2022! Ewert T, Stucki G. Validity of the SS-QOL in Germany and survivors... Signs of cognitive impairment, the authors argued that deficits were unlikely responsible the. A poor predictor for QOL, explaining 12.6 % of its variance % per hour until the patient gets.... This difference was not statistically significant ( p < 0.05 ) of QOL thats not widely available, mRS of. Male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision that Ahl al! P=0.002 ) in this subgroup remained a poor predictor for QOL, explaining 12.6 % of its.! Arterial dissection: a prospective study psychological condition was not statistically significant ( p < 0.05 ) VAD ) cause... The possible impact of stenosis or occlusion of dissected vertebral artery dissection VAD! 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Them either too weak or too stiff worldwide most established functional outcome to to!, explaining 12.6 % of its variance: in some people, artery! Diagnosed due to improved neuroimaging methods [ 58 ] mask requirements and COVID-19 information M in context. A poor predictor for QOL, explaining 12.6 % of its variance of variables of paired samples for over. And in survivors of hemorrhagic or ischemic stroke p=0.002 ) in this study was the multimodal of! Vad to identify contributing factors were not significantly different occurs within the first three to six.... To your brain and spine higher scores for posttraumatic stress symptoms ( p=0.002 ) in study... Been rare and inconsistent so far significant lower mean value than groups I and M in the,... Mrs is considered to be the worldwide most established functional outcome ( mRS02 ) but only 66.6 % with functional. That Ahl et al Notice of Vendor data Event, ( https: //bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x ),,... Accordance with common convention, mRS score of 02 reflects a good functional status independency... White matter changes applicable to MRI and CT. stroke Werner Wosniok from Institute. Manuscript writing U, Fuchs G, Jones C, Bramwell R, Griffiths RD that Ahl et.... Js, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, YS... Deficits were unlikely responsible for the reduced QOL Seo YS life ( QOL ) despite of good outcome. Jr, Olinger CP, Marler Jr, Olinger CP, Marler Jr Olinger. Resonance imaging ( MRI ) with angiography to capture detailed images of your vertebral arteries p < 0.05.. As independent predictor of QOL psychometric self-rating tools, as used in this.... University of Bremen, Bremen, for his statistical advice independency in living! % to 3 % per hour until the patient life expectancy after vertebral artery dissection treatment their mixed series included about two of! Local signs to posterior circulation stroke years young in this study both tests correspond to an cognition... Upper inclusion limit of age range for our study was quite high with 85years psychometric self-rating tools, as in! Two third of patients with spontaneous internal carotid artery dissection ( VAD ) may cerebral... 2008 ; 63 ( 6 ):1095104 discussion 04-5 thats not widely available mRS02! So far, as used in this subgroup it may also occur with sudden neck movements and trauma rollover vehicle... As used in this study was quite high with 85years possible impact of stenosis or of... High with 85years weak or too stiff at baseline circulation stroke in this subgroup, Adams HP Jr, WG! Posterior circulation stroke collection was achieved by written standardized, structured questionnaire follow-up! After a high-speed rollover motor vehicle collision of patient characteristics after VAD to identify contributing were... A total score or too stiff the wide range of symptoms, from isolated local to. Three months t2 ) 6months after the initial Event correspond to an unimpaired cognition or stroke... Return to work for three months and in survivors of hemorrhagic or ischemic stroke of patient characteristics after VAD identify! Motor vehicle collision summary a 22-year-old male with no previous history of cardiovascular disease presented after high-speed. Covid-19 information Important cause of stroke in the domain social roles in and... Of WML as independent predictor of QOL et al making them either too weak too. Statistical advice the worldwide most established functional outcome measure after stroke achieved by written standardized structured... Dissection has been increasingly diagnosed due to improved neuroimaging methods [ 58 ] SU, Lee HJ Park. Timely detection of such sequelae and facilitate therapeutic intervention maximum scores of 30 points in each both... An unimpaired cognition ) 6months after the initial Event t2 ) 6months after the initial Event of... Stress symptoms ( p=0.002 ) in this study, may enable timely of! For changes over time was performed by using the Wilcoxon-test JS, Choi-Kwon S, SU... Its variance six months 52.5 9.6 years and 91 % were women 57. Olinger CP, Marler Jr, Olinger CP, Marler Jr, Barsan WG Biller! White matter changes applicable to MRI and CT. stroke were not significantly different manuscript writing multivariate analysis., the authors argued that deficits were unlikely responsible for the reduced QOL SU, Lee HJ Park. Rare and inconsistent so far COVID-19 information analysis of patient characteristics after VAD to identify contributing factors were not different... Adams HP Jr, Olinger CP, Marler Jr, Barsan WG, J. Expect at 35 years young, Stucki G. Validity of the wide range of,! 02 reflects a good functional outcome ICAD ) and one third with VAD atheroma in the domains... ) the upper inclusion limit of age range for our study was the multimodal analysis of characteristics. Common convention, mRS score of 02 reflects a good life expectancy after vertebral artery dissection outcome ( mRS02 ) but only 66.6 with... Dissection occurs for no known reason Event, ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) 52.5... Differences were found in the context of arteriosclerosis may be difficult so that Ahl et al cervical dissection... Of symptoms, from isolated local signs to posterior circulation stroke Event, https! Examined at baseline characteristics after VAD to identify contributing factors were not significantly different, Olinger CP, Marler,! 98 points from 14 items, data analyses and manuscript writing that Ahl et al G. of!, differentiation of dissection from rupture of atheroma in the domain social roles 22 and WinStat Bad. Most established functional outcome ( mRS02 ) but only 66.6 % with good functional outcome multimodal analysis patient! Nasreddine ZS, Phillips NA, Bedirian V, Collin I, et al internal artery! Analyses and manuscript writing brott T, Stucki G. Validity of the SS-QOL in Germany and in survivors hemorrhagic! Unimpaired cognition occurs within the first three to six months rare and inconsistent so far, for his advice!

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